This article is more than 5 years old. Information may no longer be current.
CMS releases payment information for endoscopic fundoplication for GERD
CMS has released fee schedules for endoscopic fundoplication procedures for the treatment of GERD following the AMA’s decision to create a new Category I Current Procedural Terminology code earlier this year, according to a press release.
Anticipated to take effect on January 1, 2016, the payment value for CPT code 43210 for physicians is 12.43 total relative value units (RVU) corresponding to a $445.34 national unadjusted payment amount, while the payment value for outpatient hospitals is a $3,613.57 national unadjusted payment amount based on Ambulatory Payment Classification 5331, according to the press release.
“The new reimbursement values reflect the medical community’s recognition of transoral procedures such as MUSE [Medigus Ultrasonic Surgical Endostapler] as valuable clinical options for physicians and patients,” Chris Rowland, CEO of Medigus, said in the press release. “CMS’ decision could further support the growing availability of MUSE in the U.S. by providing physicians with appropriate reimbursement for procedures completed with MUSE.”
CMS is given an RVU for each CPT code by the AMA’s Specialty Society Relative Value Scale Update Committee, which is based on physician’s work, practice expenses and malpractice insurance, according to the press release. The AGA, ACG, ASGE, ASGS and SAGES were included in the expert panel who reviewed and approved this recommendation.
“Now that RVU and APC assignments for the new Category 1 CPT code 43210 have been finalized for use, health care providers should have a more effective pathway to appropriately receive reimbursement,” Philip Macdonald, vice president of health care economics, policy and reimbursement for EndoGastric Solutions, said in a separate press release. “A larger percentage of GERD sufferers will have access to the TIF procedure [transoral incisionless fundoplication] as an option to resolve their chronic symptoms and help improve their quality of life.”
Reference: